Laparoscopic management of an ovarian steroid cell tumor, not otherwise specified causing virilization and amenorrhea: a case report

Abstract

Steroid cell tumors account for less than 0.1% of all ovarian tumors. There are three steroid cell tumor subtypes: steroid cell tumor not otherwise specified (NOS), stromal luteoma and Leydig cell tumor. Steroid cell tumor, NOS, is the most common type and has malignant potential. We report the case of 39-year-old woman complaining of pelvic pain and amenorrhea. Physical examination revealed hirsutism. Transvaginal ultrasound showed an hyperechogenic homogenous cyst of 4 centimeters of the left ovary without signs of malignancy. The right adnexa was normal. MRI imaging showed a left ovarian mass of 34 mm × 30 mm with enhancement after intravenous gadolinium. A left salpingo-oophorectomy was carried out with peritoneal cytology by laparoscopy. Histology concluded to a steroid cell tumor not otherwise specified, which had a low malignant potential. After 2 months, we noticed the regression of hirsutism and the patient had normal menses. She's currently pregnant at 6 months of gestation. A complete surgical staging will be achieved after childbearing.

An Early Diagnosis of an Ovarian Steroid Cell Tumor Not Otherwise Specified in a Woman

“…If this tumor was the cause of infertility in this woman is not established, since there are reported cases of diagnosis in pregnant women and in our case the woman maintained regular menses [4, 6]. Also, there were already described cases of spontaneous pregnancies after removal of the tumor, not verified so far in this case [5, 8].…”

“…The mainstay treatment of ovarian steroid cell tumors is total abdominal hysterectomy with bilateral salpingo-oophorectomy and complete surgical staging. But, for those who desire to preserve fertility, conservative surgery with unilateral oophorectomy can be accepted [2, 8]. As in the case described, the tumor was an unexpected finding, and a laparoscopic cystectomy was held with close surveillance of hormonal levels and imaging in the postoperative period.…”

Failure of multiple surgical procedures and adjuvant chemotherapy in early-stage steroid-cell ovarian tumor treatment: a case report and literature review

“… 15 In addition, there have already been reported cases of spontaneous pregnancies after tumor removal, probably because of the decline in testosterone levels. 21 , 22 …”

“…15 In addition, there have already been reported cases of spontaneous pregnancies after tumor removal, probably because of the decline in testosterone levels. 21,22 Surgical treatments using total abdominal hysterectomy and bilateral salpingo-oophorectomy are an appropriate management option for postmenopausal patients and those who have completed childbearing. Endometrial sampling should be performed when fertility-sparing surgery is planned because many of these patients may have coexisting endometrial hyperplasia or even uterine adenocarcinoma that might affect the decision for performing a hysterectomy.…”